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Assessment of Ten Insulin Resistance Surrogate Indexes Predicts New-Onset Cardiovascular Disease Incidence in Patients with Prediabetes or Diabetes: Insights from CHARLS Data with Machine Learning Analysis Cover

Assessment of Ten Insulin Resistance Surrogate Indexes Predicts New-Onset Cardiovascular Disease Incidence in Patients with Prediabetes or Diabetes: Insights from CHARLS Data with Machine Learning Analysis

By: Hang Xie,  Chaoying Yan,  Yi Zheng and  Haoyu Wu  
Open Access
|Mar 2026

References

  1. Vaduganathan M, Mensah GA, Turco JV, Fuster V, Roth GA. The global burden of cardiovascular diseases and risk: A compass for future health. Journal of the American College of Cardiology. 2022;80(25):23612371. DOI: 10.1016/j.jacc.2022.11.005
  2. Li Y, Cao GY, Jing WZ, Liu J, Liu M. Global trends and regional differences in incidence and mortality of cardiovascular disease, 1990–2019: Findings from 2019 global burden of disease study. European Journal of Preventive Cardiology. 2023;30(3):276286. DOI: 10.1093/eurjpc/zwac285
  3. Center For Cardiovascular Diseases The Writing Committee Of The Report On Cardiovascular H, Diseases In China N. Report on cardiovascular health and diseases in China 2023: An updated summary. Biomedical and Environmental Sciences. 2024;37(9):949992. DOI: 10.3967/bes2024.162
  4. GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):17361788. DOI: 10.1016/S0140-6736(18)32203-7
  5. Qiu J, Li J, Xu S, Zeng H, Zhang Y, Yang S, et al. Can cardiovascular health and its modifiable healthy lifestyle offset the increased risk of all-cause and cardiovascular deaths associated with insulin resistance? Cardiovascular Diabetology. 2025;24(1):114. DOI: 10.1186/s12933-025-02674-z
  6. Li M, Chi X, Wang Y, Setrerrahmane S, Xie W, Xu H. Trends in insulin resistance: insights into mechanisms and therapeutic strategy. Signal Transduction and Targeted Therapy. 2022;7(1):216. DOI: 10.1038/s41392-022-01073-0
  7. Tao S, Yu L, Li J, Wu J, Huang X, Xie Z, et al. Insulin resistance quantified by estimated glucose disposal rate predicts cardiovascular disease incidence: a nationwide prospective cohort study. Cardiovascular Diabetology. 2025;24(1):161. DOI: 10.1186/s12933-025-02672-1
  8. Lee M, Saver JL, Hong KS, Song S, Chang KH, Ovbiagele B. Effect of pre-diabetes on future risk of stroke: Meta-analysis. BMJ (Clinical Research Ed). 2012;344:e3564. DOI: 10.1136/bmj.e3564
  9. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):22152222. DOI: 10.1016/S0140-6736(10)60484-9
  10. Rebelos E, Honka MJ. PREDIM index: a useful tool for the application of the euglycemic hyperinsulinemic clamp. Journal of Endocrinological Investigation. 2021;44(3):631634. DOI: 10.1007/s40618-020-01352-z
  11. Jiang L, Zhu T, Song W, Zhai Y, Tang Y, Ruan F, et al. Assessment of six insulin resistance surrogate indexes for predicting stroke incidence in Chinese middle-aged and elderly populations with abnormal glucose metabolism: A nationwide prospective cohort study. Cardiovascular Diabetology. 2025;24(1):56. DOI: 10.1186/s12933-025-02618-7
  12. Zhang H, Tu Z, Liu S, Wang J, Shi J, Li X, et al. Association of different insulin resistance surrogates with all-cause and cardiovascular mortality among the population with cardiometabolic multimorbidity. Cardiovascular Diabetology. 2025;24(1):33. DOI: 10.1186/s12933-025-02576-0
  13. Zhao E, Wang R, Chen Y, Xie H, Gao Y, Dong B, et al. Evaluation of a new TyG indicator, TyHGB, in predicting non-alcoholic fatty liver disease: evidence from two independent populations. Lipids in Health and Disease. 2025;24(1):342. DOI: 10.1186/s12944-025-02742-z
  14. Yi J, Qu C, Li X, Gao H. Insulin resistance assessed by estimated glucose disposal rate and risk of atherosclerotic cardiovascular diseases incidence: The multi-ethnic study of atherosclerosis. Cardiovascular Diabetology. 2024;23(1):349. DOI: 10.1186/s12933-024-02437-2
  15. Bello-Chavolla OY, Almeda-Valdes P, Gomez-Velasco D, Viveros-Ruiz T, Cruz-Bautista I, Romo-Romo A, et al. METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes. European Journal of Endocrinology. 2018;178(5):533544. DOI: 10.1530/EJE-17-0883
  16. Cui C, Qi Y, Song J, Shang X, Han T, Han N, et al. Comparison of triglyceride glucose index and modified triglyceride glucose indices in prediction of cardiovascular diseases in middle aged and older Chinese adults. Cardiovascular Diabetology. 2024;23(1):185. DOI: 10.1186/s12933-024-02278-z
  17. Dong B, Chen Y, Yang X, Chen Z, Zhang H, Gao Y, et al. Estimated glucose disposal rate outperforms other insulin resistance surrogates in predicting incident cardiovascular diseases in cardiovascular-kidney-metabolic syndrome stages 0–3 and the development of a machine learning prediction model: A nationwide prospective cohort study. Cardiovascular Diabetology. 2025;24(1):163. DOI: 10.1186/s12933-025-02729-1
  18. Liu L, Peng J, Wang N, Wu Z, Zhang Y, Cui H, et al. Comparison of seven surrogate insulin resistance indexes for prediction of incident coronary heart disease risk: A 10-year prospective cohort study. Frontiers in Endocrinology. 2024;15:1290226. DOI: 10.3389/fendo.2024.1290226
  19. Park HM, Han T, Heo SJ, Kwon YJ. Effectiveness of the triglyceride-glucose index and triglyceride-glucose-related indices in predicting cardiovascular disease in middle-aged and older adults: A prospective cohort study. Journal of Clinical Lipidology. 2024;18(1):e70e79. DOI: 10.1016/j.jacl.2023.11.006
  20. Li F, Wang Y, Shi B, Sun S, Wang S, Pang S, et al. Association between the cumulative average triglyceride glucose-body mass index and cardiovascular disease incidence among the middle-aged and older population: A prospective nationwide cohort study in China. Cardiovascular Diabetology. 2024;23(1):16. DOI: 10.1186/s12933-023-02114-w
  21. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. European Heart Journal. 2013;34(38):29493003. DOI: 10.1093/eurheartj/eht296
  22. Gao K, Cao LF, Ma WZ, Gao YJ, Luo MS, Zhu J, et al. Association between sarcopenia and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study. EClinicalMedicine. 2022;44:101264. DOI: 10.1016/j.eclinm.2021.101264
  23. Mo D, Zhang P, Zhang M, Dai H, Guan J. Cholesterol, high-density lipoprotein, and glucose index versus triglyceride-glucose index in predicting cardiovascular disease risk: A cohort study. Cardiovascular Diabetology. 2025;24(1):116. DOI: 10.1186/s12933-025-02675-y
  24. Beretta L, Santaniello A. Nearest neighbor imputation algorithms: A critical evaluation. BMC Medical Informatics and Decision Making. 2016;16(Suppl 3):74. DOI: 10.1186/s12911-016-0318-z
  25. Zhao E, Xie H, Zhang Y. Predicting diagnostic gene biomarkers associated with immune infiltration in patients with acute myocardial infarction. Frontiers in Cardiovascular Medicine. 2020;7:586871. DOI: 10.3389/fcvm.2020.586871
  26. Kursa MB, Rudnicki WR. Feature selection with the Boruta package. Journal of Statistical Software. 2010;36(11):113. DOI: 10.18637/jss.v036.i11
  27. Williams KV, Erbey JR, Becker D, Arslanian S, Orchard TJ. Can clinical factors estimate insulin resistance in type 1 diabetes? Diabetes. 2000;49(4):626632. DOI: 10.2337/diabetes.49.4.626
  28. Zhang Z, Tan L. Association of insulin resistance-related indicators with cardiovascular disease in Chinese people with different glycemic states. Frontiers in Endocrinology. 2025;16:1515559. DOI: 10.3389/fendo.2025.1515559
  29. Zabala A, Darsalia V, Lind M, Svensson AM, Franzén S, Eliasson B, et al. Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: A nationwide cohort study. Cardiovascular Diabetology. 2021;20(1):202. DOI: 10.1186/s12933-021-01394-4
  30. Lu Z, Xiong Y, Feng X, Yang K, Gu H, Zhao X, et al. Insulin resistance estimated by estimated glucose disposal rate predicts outcomes in acute ischemic stroke patients. Cardiovascular Diabetology. 2023;22(1):225. DOI: 10.1186/s12933-023-01925-1
  31. Guo L, Zhang J, An R, Wang W, Fen J, Wu Y, et al. The role of estimated glucose disposal rate in predicting cardiovascular risk among general and diabetes mellitus population: A systematic review and meta-analysis. BMC Medicine. 2025;23(1):234. DOI: 10.1186/s12916-025-04064-4
  32. Bahrami Hezaveh E, Hashemi R, Noorafrooz M, Mohammadi F, Yadegar A, Karimpour Reyhan S, et al. Estimated glucose disposal rate: A potential determinant for microvascular and macrovascular complications in type 2 diabetes. Endocrinology, Diabetes & Metabolism. 2025;8(2):e70037. DOI: 10.1002/edm2.70037
  33. Adeva-Andany MM, Martínez-Rodríguez J, González-Lucán M, Fernández-Fernández C, Castro-Quintela E. Insulin resistance is a cardiovascular risk factor in humans. Diabetes & Metabolic Syndrome. 2019;13(2):14491455. DOI: 10.1016/j.dsx.2019.02.023
  34. Xia MF, Chen Y, Lin HD, Ma H, Li XM, Aleteng Q, et al. A indicator of visceral adipose dysfunction to evaluate metabolic health in adult Chinese. Scientific Reports. 2016;6:38214. DOI: 10.1038/srep38214
  35. Yang Y, Li S, Ren Q, Qiu Y, Pan M, Liu G, et al. The interaction between triglyceride-glucose index and visceral adiposity in cardiovascular disease risk: Findings from a nationwide Chinese cohort. Cardiovascular Diabetology. 2024;23(1):427. DOI: 10.1186/s12933-024-02518-2
  36. Liu L, Peng J, Zang D, Zhang Y, Wu Z, Song C, et al. The Chinese visceral adiposity index: A novel indicator more closely related to cardiovascular disease than other abdominal obesity indices among postmenopausal women. Journal of Translational Medicine. 2024;22(1):855. DOI: 10.1186/s12967-024-05665-y
  37. Qiao T, Luo T, Pei H, Yimingniyazi B, Aili D, Aimudula A, et al. Association between abdominal obesity indices and risk of cardiovascular events in Chinese populations with type 2 diabetes: A prospective cohort study. Cardiovascular Diabetology. 2022;21(1):225. DOI: 10.1186/s12933-022-01670-x
  38. Zhang Z, Zhao L, Lu Y, Meng X, Zhou X. Association between Chinese visceral adiposity index and risk of stroke incidence in middle-aged and elderly Chinese population: Evidence from a large national cohort study. Journal of Translational Medicine. 2023;21(1):518. DOI: 10.1186/s12967-023-04309-x
  39. Shulman GI. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. The New England Journal of Medicine. 2014;371(12):11311141. DOI: 10.1056/NEJMra1011035
  40. Frigolet ME, Torres N, Tovar AR. The renin-angiotensin system in adipose tissue and its metabolic consequences during obesity. The Journal of Nutritional Biochemistry. 2013;24(12):20032015. DOI: 10.1016/j.jnutbio.2013.07.002
  41. Lear SA, Humphries KH, Kohli S, Birmingham CL. The use of BMI and waist circumference as surrogates of body fat differs by ethnicity. Obesity. 2007;15(11):28172824. DOI: 10.1038/oby.2007.334
  42. Abu Alfeilat HA, Hassanat ABA, Lasassmeh O, Tarawneh AS, Alhasanat MB, Eyal Salman HS, et al. Effects of distance measure choice on K-nearest neighbor classifier performance: A review. Big Data. 2019;7(4):221248. DOI: 10.1089/big.2018.0175
  43. Krittanawong C, Zhang H, Wang Z, Aydar M, Kitai T. Artificial intelligence in precision cardiovascular medicine. Journal of the American College of Cardiology. 2017;69(21):26572664. DOI: 10.1016/j.jacc.2017.03.571
  44. Boden G, Shulman GI. Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and beta-cell dysfunction. European Journal of Clinical Investigation. 2002;32(Suppl 3):1423. DOI: 10.1046/j.1365-2362.32.s3.3.x
  45. Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Research and Clinical Practice. 2014;105(2):141150. DOI: 10.1016/j.diabres.2014.04.006
  46. Vazzana N, Ranalli P, Cuccurullo C, Davì G. Diabetes mellitus and thrombosis. Thrombosis Research. 2012;129(3):371377. DOI: 10.1016/j.thromres.2011.11.052
  47. Vaidya RA, Desai S, Moitra P, Salis S, Agashe S, Battalwar R, et al. Hyperinsulinemia: an early biomarker of metabolic dysfunction. Frontiers in Clinical Diabetes and Healthcare. 2023;4:1159664. DOI: 10.3389/fcdhc.2023.1159664
  48. Festa A, Williams K, Hanley AJ, Otvos JD, Goff DC, Wagenknecht LE, et al. Nuclear magnetic resonance lipoprotein abnormalities in prediabetic subjects in the Insulin Resistance Atherosclerosis Study. Circulation. 2005;111(25):34653472. DOI: 10.1161/CIRCULATIONAHA.104.512079
  49. Fiorentino TV, Prioletta A, Zuo P, Folli F. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Current Pharmaceutical Design. 2013;19(32):56955703. DOI: 10.2174/1381612811319320005
  50. Stirban A, Gawlowski T, Roden M. Vascular effects of advanced glycation endproducts: Clinical effects and molecular mechanisms. Molecular Metabolism. 2014;3(2):94108. DOI: 10.1016/j.molmet.2013.11.006
  51. Webb AJS, Werring DJ. New insights into cerebrovascular pathophysiology and hypertension. Stroke. 2022;53(4):10541064. DOI: 10.1161/STROKEAHA.121.035850
  52. Liu S, Li Y, Zeng X, Wang H, Yin P, Wang L, et al. Burden of cardiovascular diseases in China, 1990–2016: Findings from the 2016 Global Burden of Disease Study. JAMA Cardiology. 2019;4(4):342352. DOI: 10.1001/jamacardio.2019.0295
DOI: https://doi.org/10.5334/gh.1532 | Journal eISSN: 2211-8179
Language: English
Submitted on: May 29, 2025
|
Accepted on: Feb 20, 2026
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Published on: Mar 12, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2026 Hang Xie, Chaoying Yan, Yi Zheng, Haoyu Wu, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.